Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection.

Conference Paper

BACKGROUND: The aim of this study was to investigate the rate and pattern of recurrence after curative intent resection of perihilar cholangiocarcinoma (PHC). STUDY DESIGN: Patients were included from 2 prospectively maintained databases. Recurrences were categorized by site. Time to recurrence and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method. Cox proportional hazards modeling was used to identify independent poor prognostic factors. RESULTS: Between 1991 and 2012, 306 consecutive patients met inclusion criteria. Median overall survival was 40 months. A recurrence was diagnosed in 177 patients (58%). An initial local recurrence was found in 26% of patients: liver hilum (11%), hepaticojejunostomy (8%), liver resection margin (8%), or distal bile duct remnant (2%). An initial distant recurrence was observed in 40% of patients: retroperitoneal lymph nodes (14%), intrahepatic away from the resection margin (13%), peritoneum (12%), and lungs (8%). Only 18% of patients had an isolated initial local recurrence. The estimated overall recurrence rate was 76% at 8 years. After a recurrence-free period of 5 years, 28% of patients developed a recurrence in the next 3 years. Median RFS was 26 months. Independent prognostic factors for RFS were resection margin, lymph node status, and tumor differentiation. Only node-positive PHC precluded RFS beyond 7 years. CONCLUSIONS: Perihilar cholangiocarcinoma will recur in most patients (76%) after resection, emphasizing the need for better adjuvant strategies. The high recurrence rate of up to 8 years justifies prolonged surveillance. Only patients with an isolated initial local recurrence (18%) may have benefited from a more extensive resection or liver transplantation. Node-positive PHC appears incurable.

Full Text

Duke Authors

Cited Authors

  • Groot Koerkamp, B; Wiggers, JK; Allen, PJ; Besselink, MG; Blumgart, LH; Busch, ORC; Coelen, RJ; D'Angelica, MI; DeMatteo, RP; Gouma, DJ; Kingham, TP; Jarnagin, WR; van Gulik, TM

Published Date

  • December 2015

Published In

Volume / Issue

  • 221 / 6

Start / End Page

  • 1041 - 1049

PubMed ID

  • 26454735

Pubmed Central ID

  • PMC4736142

Electronic International Standard Serial Number (EISSN)

  • 1879-1190

Digital Object Identifier (DOI)

  • 10.1016/j.jamcollsurg.2015.09.005

Conference Location

  • United States